Background:
Graphic health warning labels (GHWLs) not only induce smoking cessation among smokers, but also are effective in preventing smoking initiation of non-smokers especially young people. For this reason, the WHO FCTC and its guidelines recommend each Party to introduce a warning within three years of its entry into force, preferably with the use of pictorials. And the guidelines recommend placing GHWLs at top of packs to increase visibility and legibility. Therefore, this study investigated whether the position of GHWLs affects visual attention.

Methods:
Thirty daily smokers and twenty-four non-smokers participated in this study. Participants (30 male, 24 female) mean age was 32.31 years (SD = 6.43). The eye movements of participants were recorded by an eye-tracking equipment and measured viewing time, or fixation time, in milliseconds. Participants saw 6 cigarette packs from different combinations of 3 positions (top, middle, bottom) and 2 concepts (skin aging, toxic constituents). Size of the GHWL was 30% of the pack while tobacco branding covered 50% of the pack.

Results:
Overall, Participants spent more time looking at the health warning area than in the tobacco branding area. When GHWL was displayed at the top of the pack, participants spent longer time to look at the health warning area compared to the bottom position.

Conclusions:
GHWLs displayed at the top of the pack appear to increase visual attention of health warning while tobacco brand area getting less attention. Findings suggest that positioning GHWLs at the top of the pack is more visible and legible than at the bottom.